Research methodology for cardiovascular surgery clinicians

1. Clinical Research and
Paper in CVS
Robert Chen

2. Outlines
• Data Source(s)
• Journals and Paper Submission
• Examples of Submitted Papers
• Topics Welcome

3. Motivation
• How well are we doing? Benchmark.
• How is the operation risk from
experience?
• Papers

4. 4
Database Example

6. Data Variables
(Computer)
• Text
• Number
• Date
• Administrative data

7. Data Variables
(Epidemiology)
• X1, X2, ..., Xn -> Y
• Predictor: Xi
• Outcome: Y

8. Data Variables
(Statistics)
• Scale: Continuous. eg. body weight
• Ordinal: Grading. eg. severity
• Nominal: Category. eg. location

9. Data Variables
(Surgery)
• Demographics
• Baseline
• Preop
• Op
• Postop
• Outcome

10. Variable Content
• Yes / No
• Timing
• Category
• Measurement

11. Paperwork
• Question
• Grant (optional, if big research)
• Data collection
• Analysis
• Paper writing
• Submission and revision

12. Data Source
• FEMH CVS Database
• National Health Insurance Database
• FEMH Hospital Database

14. CVS Database
• Basic data
• Risk factors
• Preop Intervention
• Symptoms/Signs
• Preop Cardiac Condition
• Hemodynamics
• Preop Meds

15. CVS Database
• Mechanical Circulatory Support
• Preop Assessment
• CPB (perfusionist)
• Operation Intro (OR)
• Op CABG
• Op Valve

16. CVS Database
• Op MICS
• Op Others Cardiac
• Op Others Non-cardiac
• Postop Conditions
• Complications

17. CVS Database
• Death
• Discharge
• Re-admission

18. Process
• 13 F, Database specialist 林孟葦
• Time range
• Diagnosis or procedures
• Variables (from questions)

19. Process
• Excel data spreadsheet
• Statistics analysis
• Paper writing and submission
• Revision

21. http://w3.nhri.org.tw/nhird
21

23. 23

27. ICD-9 Codes and Diagnoses
 DM=250.*
 COPD=490-492.* or 496
 PAOD=443.*-444.*
 CVA 434.91 or 434.11 or 997.02
 Acute renal failure=584.*
 Chronic renal failure=586.*-588.*
 Critical=785.51 or “shock” or “IABP” or “ECMO”
 UA=413.* or “angina”
 LV dysfunction = 428.* or “critical” or “CHF” or “ICMP”
 AMI=410.* or “AMI” or “infarction”
 PHT=416.* or “pulmonary hypertension”
 IE=424.*

28. Nat’l Health Insurance Code
Operations Postop Course
 CABG*1= 68023
 CABG+LIMA= 68023X1/2
 CABG*2=68024
 CABG*3=68025
 MVA/TVA=68015
 AVR/MVR/TVR=68016
 DVR=68017
 AVR+MVR+TVR=68018
 Redo=68003
 Ventilator=57001
 IABP=33079
 HD=58001
 CVVH=58014
 “Text data-mining”

33. Hospital Information
System (HIS)
• Help from IT
• Variable definitions
• SQL (Structured Query Language)
• SELECT [X1], [X2] FROM [DB] WHERE
[X3] ? [X4]
• Xi? DB?

34. Data Collection from
HIS
• Diagnosis: ICD9
• Operation: NHI
• Procedures: NHI
• IABP, MV, HD,...
• Drugs: ?

35. Data Analysis: Statistics
• Descriptive ( 敘述性 ): Tables, Graphs
• Inferential ( 推論性 ): p-values

37. Inferential Statistics
• Different or not?
• Related or not?
• Predictor or not?

38. Different?
• Groups
• Variables to compare

39. Related?
• Correlation
• Variable-1
• Variable-2

40. Predictors?
• Predictor variables X1, X2,...Xn
• Outcome variable Y
• Scale
• Event (Y/N)
• Time-event

43. Journals
• JCR 2011 Ranking
• Impact Factors
• Different journals, different rules

53. EndNote X5

55. Submitted
• Pigtail delivery of cardioplegia for minimally
invasive mitral valve surgery
• Parasternal minimally invasive cardiac surgery
• Comparative Study of Serum Amyloid A and C-
Reactive Protein in Patients undergoing Off-
pump Coronary Artery Bypass Surgery
• Comparing the endothelial integrity of the
saphenous vein grafts harvested by the
endoscopic and open techniques

56. Potential Topics
• MICS vs. conventional for outcomes and
complications
• Limiting factors of MICS
• NHID valve mechanical vs. bio for outcomes and
complications
• Aortic bifurcation angle and cross-over tech
success rate

57. Welcome Ideas
• Interesting topics
• Questions
• Then we can go on to papers

58. DEMO